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Should I Continue Sertraline Again For Anxiety?

Posted on Fri, 4 Apr 2014

Question: Hello, I am under anxiety treatment (panic attacks) since last october. When i started taking nebivolol 5 mg, sertraline before 50 mg now 100 mg and requip 4 mg. Anyway i am doing pretty good, but i noticed that since i doubled my dose of zoloft from 50 to 100 my triglycerides have raised consistely from 117 in october, to 177 in january and now in march more than 200. I need to do something. Should i decrease sertraline again? Or switching to fluoxetine? I read that it actually lowers triglycerides? Please help. Thank you

Answered by Dr. Srikanth Reddy (1 hour later)

Brief Answer: Clarifications Detailed Answer: Hello, Thanks for using health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. However I would require a couple of more details to help you in answering your query in a better justified way. 1. Are on any treatment for increased triglycerides? 2. How are your sugar and cholesterol levels? 3. Do you have hypertension or diabetes? 4. Is there any other medications that you are on? Hope to hear from you at your earliest convenience. Regards and wish you good health, Dr. Srikanth Reddy MD Neuro-Psychiatrist and Sexologist Neuro-Psychiatrist and Sexologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Srikanth Reddy (13 minutes later)

Hello, Thanks for your questions. 1. No i am not taking any medicine to lower triglycerides 2. My fasting sugar is around 80mg/dl, LDL is 69 mg/dl, HDL is 54mg/dl, Total Cholesterol is 158 mg/dl and triglycerides are 204 mg/dl 3. Before i started nebivolol in october i had slight hypertension 150/85 4. I am not taking other medicine except the ones i mentioned in this answer and in the first post. Thank yo 3. u

Answered by Dr. Srikanth Reddy (9 hours later)

Brief Answer: Sertraline can increase triglycerides Detailed Answer: Hello Thanks for the additional information. Sertraline can cause increase in the triglyceride levels. Although it is not a common side-effect but it does occur many times in clinical practice. IN fact in your case the rise has been rapid and it would not be wise to continue with the drug. You certainly need to switch the medications. Among the available options, bupropion would be a good option. It is weight neutral and does cause much alteration of the triglyceride profiles. Fluoxetine is also an SSRI can also lead to the similar side-effect as sertraline and hence wont be a good option either. Also you may start some aerobic exercises. This will lower your triglyceride levels. Also you may try augmenting your antidepressant treatment with cognitive behavioural therapy. This therapy is taken by either a psychologist or a psychiatrist in which the therapist identifies impaired cognitions (Thoughts) and try to correct them. They are 15-20 min weekly session and there should be around 8-10 sessions to help you with your illness. CBT will help in lowering the required dosages of antidepressants and hence reduce the chances of adverse drug reactions. YOu may discuss with your treating psychiatrists the options of bupropion and CBT and I am sure both these steps should be helpful for you. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: bit.ly/dr-srikanth-reddy Wish you good health, Kind regards Dr. Srikanth Reddy M.D.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Srikanth Reddy (14 hours later)

Hello, Thanks for your reply, but I am not sure you understand my situation. My main problem is anxiety, tachycardia, bupropion is the worst drug, I have tried it already. I cant tolerate anything that touch norpinephrine since it increases my anxiety. Regarding fluoxetine, I am sure I read some studies where they prove it lowers triglycerides. I am just scared to switch to prozac because of the interactions with nebivolol.

Answered by Dr. Srikanth Reddy (1 hour later)

Brief Answer: Its ok to take them together Detailed Answer: Hello Thanks for expressing your concerns. Its unfortuante that you did not tolerate bupropion as it has least metoabolic problems. Fluoxetine basically will reduce the metabolism of nebivolol and will increase the blood levels. They can be taken together provided the doses of nebivolol are reduced before the start of fluoxetine. In my routine clinical practice fluoxetine has a weight reduction effect during the first 4 weeks but like wise other drugs, it will also have a weight increase effect. Agomelatonine is a new drug coming by the brand name of noveltin/agoprex and is also useful. You may keep that as an option. Regards Dr. Srikanth Reddy MD

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar